PQA Hyperlipidemia Cluster Group

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PQA Hyperlipidemia Cluster Group

• PQA Meeting
• November 20, 2006

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Cluster Group Members

• Heidi Lew chair
• Kimberly Binaso
• Curt Le
• Harvey Maldow
• Paul Mastoridis
• Eleanor Perfetto
• Anthony Provenzano
• Janelle Ruisinger
• Marissa Schlaifer, staff

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Measures Recommended

• Medication Adherence
• Percent of patients who do not experience a
  significant gap of their anti-hyperlipidemia
  medication.
• Medication Persistence
• Percent of patients who continue on their
  anti-hyperlipidemia medication at pre-defined
  periods.

4
Measures Recommended

• Medication Adherence
• This measure will determine the proportion of
  patients treated with an anti-hyperlipidemia
  medication who experience a significant gap in
  refills.
• It is calculated among all patients who have
  received at least 2 fills of an
  anti-hyperlipidemia medication during the
  measurement period (e.g., calendar year).

5
Measures Recommended

• Medication Persistence
• This measure will determine the proportion of
  patients initiated on an anti-hyperlipidemia
  medication who remain on therapy at pre-defined
  periods (e.g., 6 and 12 months).
• It is calculated among all patients who have
  newly initiated an anti-hyperlipidemia medication
  during the measurement period (e.g., calendar
  year).

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Definitions

• Significant Gap
• The duration of a gap between at least 2 fills of
  an anti-hyperlipidemia medication that is greater
  than 7 days for a 30 day fill.
• Measurement Period
• The timeframe in which the two measures will be
  assessed.
• Pre-defined Periods
• The specific time points during the measurement
  period in which medication persistence will be
  determined for the anti-hyperlipidemia
  medications.

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Rationale

• The primary objective was to select or identify
  relatively easy to determine measures which can
  be associated with optimal clinical outcome, for
  patients receiving anti-hyperlipidemia medication
  therapy.
• Medication Adherence Based on landmark studies
  in the medical literature, the greatest reduction
  of morbidity and mortality is seen in patients
  who took more than 80 of their statin
  medications.
• Medication Persistence Studies have confirmed
  that the benefits expected with statin therapy
  were only realized in those patients who
  continuously took over 80 of their medication.

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Medication Adherence Description

• Numerator
• Number of patients in the denominator who does
  not experience a significant gap of their
  anti-hyperlipidemia medication (i.e., are at
  least 80 adherent with their anti-hyperlipidemia
  medication therapy
• Denominator
• The total number of patients who have received at
  least 2 fills of an anti-hyperlipidemia
  medication during the measurement period.

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Medication Persistence Description

• Numerator
• Number of patients who remain on
  anti-hyperlipidemia therapy at 6 months (and at
  12 months), following receipt of their first
  anti-hyperlipidemia prescription medication.
• Denominator
• The total number of patients who have initiated
  an anti-hyperlipidemia medication during the
  measurement period.

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Adherence Measure Comments

• For medication persistence, the group recommends
  that persistence should be measured
• At timeframe of 6 months
• At timeframe of 12 months
• At the conclusion of a pilot testing program, the
  pilot data should be used to better understand
  the most appropriate duration.

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Medications to Be Included

• Statins
• Atorvastatin
• Fluvastatin
• Fluvastatin ER
• Lovastatin ER
• Lovastatin IR
• Pravastatin
• Rosuvastatin
• Simvastatin

• Statin Combinations
• Lovastatin/niacin ER
• Simvastatin/ezetimibe
• Not included
• Aspirin/pravastatin
• Atorvastatin/amlodipine

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Medications to Be Included

• Other
• Cholestyramine
• Colesevelam HCl
• Colestipol HCL
• Ezetimibe
• Fenofibrate
• Micronized fenofibrate
• Gemfibrozil
• Niacin ER
• Niacin IR

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Additional Information

• Cluster group did discuss drug-drug interactions
  as a potential measure
• The group determined that there are no drug-drug
  interactions in the statin class that are
  clinically significant at a level that would be
  appropriate to be used to evaluate a
  pharmacy/pharmacist level of service